Diagnosing Prostate Cancer - How Many Doctors Does It Take To Get It Wrong

Many of us have had the experience of seeking out a second opinion on a medical issue only to find out that the two doctors we consult do not agree with each other. When a misdiagnosis could literally mean the difference between life and death this can present a serious problem for the patient.

When the patient is made aware of each doctor's conclusions and the rationale behind those conclusions then at least the patient can make an informed decision based on his or her level of risk tolerance. It becomes more complicated, however, when the one doctor who is on the right track ends up not communicating his or her suspicions and the other doctors are missing the signs and not ordering the right tests.

One such situation arose in the following case:

Several doctors had an opportunity to diagnose their male patient's prostate cancer while it was in its early stages. The patient first saw his primary care physician, a general practitioner, with urinary problems when he was 56 years old. The general practitioner concluded that the problems were not related to cancer although no testing was done to rule out cancer. Ten months later the patient consulted with a urologist who performed a digital examination on the prostate gland and ordered a PSA blood test. As it turned out this urologist was not an approved provider under the patient's insurance and so the patient consulted with a second urologist.

Although the blood test results came in neither the results of the test nor the first urologist's suspicion of cancer and recommendation that a biopsy be conducted were communicated to the patient's primary care physician or to his second urologist. The second urologist concluded that the examination of the prostate was normal and that there was no evidence of cancer. As such the cancer went undiagnosed for two years at which time it had spread beyond the prostate. The physicians treating the patient's cancer concluded that he likely had only one to five years to life as a result of the cancer's spread. The law firm that handled this matter reported that they were able to achieve a settlement during jury selection at trial in the amount of $2.5 million on behalf of the patient.

In this case example it is interesting to note that both the general practitioner and the second urologist missed an opportunity to order PSA testing. This is a simple blood test that measures the amount of protein-specific antigen in the blood stream. This antigen is produced in men by the prostate gland. An elevated level of the antigen in the bloodstream can be caused by cancer of the prostate.

Because the level of antigen can be elevated for reasons other than prostate cancer an abnormally high test result is generally followed by diagnostic testing to determine whether the patient has prostate cancer that is causing the abnormal PSA levels. So while it would not have been conclusive by not ordering a PSA test the general practitioner and the second urologist failed to obtain a crucial piece of information that might have led them to the correct diagnosis.

The general practitioner also failed to perform a digital examination to determine whether there was any palpable abnormality to the prostate gland. The second urologist conducted a digital examination but failed to pick up any abnormality of the gland. The second urologist thus relied on only one test - a test that is unreliable for two main reasons. First, the digital examination only allows access to part of the prostate. If there is an abnormality to the part of the gland that cannot be reached during the examination the abnormality will not be found. Second, the digital examination is only as good as the sensitivity of the physician conducting it to detect an abnormality.

This case thus illustrates two main types of failures. There was the failure on the part of the general practitioner and the second urologist not following the proper screening guidelines. And there was the failure of communication among the different physicians. Although it impossible to know whether the general practitioner or the second urologist would have followed up on results of the PSA test from the first urologist or on that urologist's suspicion and recommendation they at least would have had information and perspective they were missing.

When physicians succumb to these types of failures and they in turn lead to a delayed diagnosis of a patient's cancer so that a cure is no longer possible then, as in the case above, the physicians may be liable for medical malpractice.